Protecting the neglected from disease: the role of gender, health equity and human rights in the fight against neglected tropical diseases

Poverty and inequality are both the starting point, and the ultimate outcome, for most neglected tropical diseases (NTDs). As a group of 20 diseases, NTDs are typified by their prevalence among the poor, excluded, and marginalised within society. In the absence of quality healthcare provision, many NTDs lead to long term disability, disfigurement, and stigma, which in turn act to reinforce the exclusion and poverty experienced by the afflicted. The path leading to illness is often determined by a widespread lack of access to formal education, timely healthcare, adequate living conditions, employment and nutrition. The reasons for such deprivation are complicated, but ultimately reduce to a persistence of inequalities in affected regions. These inequalities can manifest differently depending on the demographic being studied: gender, ethnicity, geographic location, level of formal education, can all determine the ease with which NTDs are transmitted, diagnosed or treated. Yet, regardless of contextual differences, NTDs continue to persist because individuals within endemic regions experience a healthcare system that is, either directly or indirectly, inequitable. The healthcare system referred to in this context is not confined to simply formal healthcare settings. Rather, it encompasses local healers, community healthcare professionals or volunteers, drug administration programmes, community mental health provision, the formal education system, and, in extension, even the infrastructure that exists to physically connect individuals to their healthcare provider. Failing to ensure parity across each of these components for every citizen equates to a discriminatory healthcare system which fails to recognise the individual’s basic human right to “a standard of living adequate for the health and well-being of themselves and of their family, including food, clothing, housing and medical care and necessary social services” (Article 25- Universal Declaration of Human Rights). To ensure NTDs are managed in a way that is sustainable in the long term, the underlying societal inequalities which allow them to persist must be first understood.